Improving the Emotional Work Environment for Nurses

Creating and sustaining a healthy professional practice environment is the primary work of the nurse executive and leadership. The rapid pace of change in modern healthcare can have significant consequences such as conflict, stress and bullying. These negative changes affect not only the emotional work life of nurses, but also place patients at risk. Meeting the triple aims of better healthcare, better health outcomes at lower cost means remaining vigilant for cost reductions, productivity improvements, and quality improvements, while working toward the vision of IOM Future of Nursing Report.

In 2010, the nursing leadership of a large nonprofit center in the southwest committed to improving the practice environment, creating a healthy work environment, and achieving Magnet re-designation in a time of tumultuous change and internal turmoil. We used a CNO created framework of 4CP (caring + compassionate + competent + courageous = Professional) built on Positive Deviance Methodology, Courage & Renewal philosophy, Nurse Manager Engagement Theory, and moral courage model. The transformation process included intentional work in reflection, respect, recovery and redirection with clinical staff, leadership, the board, and the community.

Nursing leadership selected existing metrics to measure the success of the transformation to provide a baseline for comparison over time. Improvements in National Database of Nursing Quality Improvement nurse engagement scores increased from an overall mean Practice Environment Scale of 3.02 to 3.22, and a Job Enjoyment Scale of 60.06 to 65.96 (from below the 50^th percentile to above the 75^th).

Nursing leadership, in partnership with the direct care staff, continue working at the microsystem level on establishing a resilient and positive culture in the few remaining "pockets of chaos." This future work includes a nurse-to-nurse collaboration model, cognitive rehearsal program orientation, and ongoing self-care programs.